What is the treatment for a chalazion?

Treatment of Chalazion

The first-line treatment for chalazion is warm compresses and eyelid hygiene, with surgical intervention reserved for cases that don't respond to conservative management after 4-6 weeks. 1

Understanding Chalazion

• A chalazion is a firm, round nodule within the tarsus of the eyelid
• Characterized by gradual onset and usually painless
• Caused by retained secretions in the meibomian or Zeis glands
• Distinguished from hordeolum (stye) which is acute, painful, and caused by bacterial infection 1

First-Line Conservative Treatment

1. Warm Compresses

   • Apply to eyelids for several minutes, 1-2 times daily
   • Options include:
     • Hot tap water on a clean washcloth
     • Commercial heat pack
     • Homemade bean/rice bag heated in microwave
   • Caution: Avoid temperatures that could burn the skin 1
   • The Re-Heater or hard-boiled egg methods provide better heat retention than simple warm washcloths 2

2. Eyelid Hygiene

   • Gentle cleansing of eyelid margins
   • Use diluted baby shampoo or commercial eyelid cleaner on a cotton ball/swab
   • Hypochlorous acid 0.01% cleaners have strong antimicrobial effects 1

3. Antibiotic Ointment

   • Bacitracin or erythromycin can be applied to eyelid margins once or more daily
   • Continue for a few weeks as needed 1

Treatment Efficacy

• Conservative treatment resolves approximately 29-36% of chalazia within 4-6 weeks 3, 4
• Chalazia present for more than 2 months are less likely to resolve with conservative therapy alone 3

Second-Line Interventions

For chalazia that don't respond to conservative treatment after 4-6 weeks:

1. Incision and Drainage/Curettage

   • Surgical treatment resolves approximately 72% of selected chalazia 4
   • For anteriorly situated upper eyelid chalazia, an eyelid crease approach can provide excellent exposure with minimal discomfort 5

2. Intralesional Steroid Injection

   • Triamcinolone acetonide injection is an alternative to surgical removal 6

When to Refer

Refer patients if they experience:

• No improvement after 4-6 weeks of conservative treatment
• Recurrent chalazia in the same location (may indicate underlying conditions)
• Marked asymmetry or resistance to therapy (biopsy may be indicated) 1

Special Considerations

• Recurrent chalazia in the same location, especially in elderly patients, should be evaluated for sebaceous carcinoma 1
• Children with recurrent chalazia may have unrecognized chronic blepharokeratoconjunctivitis requiring more aggressive treatment 1
• Avoid aggressive eyelid manipulation in patients with advanced glaucoma or filtering procedures 1

Common Pitfalls to Avoid

• Using compresses that are too hot, which may burn the skin
• Failing to recognize that untreated chalazia can progress to more serious conditions
• Not completing the full treatment course
• Missing underlying conditions in cases of recurrent chalazia 1